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Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients

Louise C.D. Konijn1, Richard Ap Takx2, Pim A de Jong2

  • 1Haga Hospital, Department of Diagnostic and Interventional Radiology, the Netherlands; University Medical Center Utrecht and Utrecht University, Department of Radiology, the Netherlands.

European Journal of Radiology
|October 2, 2020
PubMed

Insights

Annular arterial calcification in the legs predicts poor survival in chronic limb-threatening ischemia (CLI) patients. This CT scan finding is a stronger predictor of mortality than traditional risk factors.

Area of Science:

  • Vascular Medicine
  • Radiology
  • Cardiovascular Imaging

Background:

  • Chronic limb-threatening ischemia (CLI) carries a high mortality rate, with 50-60% of patients dying or undergoing amputation within five years.
  • Identifying reliable prognostic markers is crucial for managing CLI patients and improving outcomes.

Purpose of the Study:

  • To evaluate the predictive value of lower extremity arterial calcification characteristics on computed tomography (CT) for amputation-free survival and all-cause mortality in CLI patients.
  • To determine if specific CT-assessed calcification patterns predict long-term outcomes in CLI.

Main Methods:

  • Retrospective analysis of 89 CLI patients who underwent lower extremity CT angiography.
  • Assessment of calcification severity, annularity, thickness, and continuity in femoropopliteal and crural arteries using a CT score.
  • Multivariate Cox regression analysis, adjusted for age and sex, to determine the predictive value of calcification characteristics on 7-year amputation-free survival and 10-year all-cause mortality.

Main Results:

  • Complete annular calcifications were prevalent in both femoropopliteal (43.7%) and crural (63.2%) arteries.
  • Patients with complete annular calcifications exhibited significantly higher 10-year all-cause mortality (adjusted HR 1.68 for femoropopliteal, P=0.04; adjusted HR 2.29 for crural, P=0.006).
  • Mean survival time was 278.4 weeks.

Conclusions:

  • Annularity of calcification in both femoropopliteal and crural arteries serves as a significant predictor of 10-year all-cause survival in CLI patients.
  • This calcification pattern demonstrates a higher hazard ratio for mortality compared to traditional prognostic risk factors for CLI.
  • CT-assessed arterial calcification annularity may play a key role in the poor prognosis observed in CLI patients.
Abstract

Keywords:
All-cause mortalityAmputation-free survivalChronic limb-threatening ischemiaComputed tomographyIntimal calcificationMedial calcificationPeripheral artery diseasePrediction models

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